| . Antiemetics
 .
 | (AE) | 
| What they do: | 
Move SN to intestines quicklyReduce vomiting It's not just to 'reducing nausea' – prevent serious vomiting (complex stomach-brain interactions) and open GI valves (sphincters).
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| Do I need it? | No, though recommended. 
 
Success / vomiting varies, so there is no definitive answer.Many used SN fatally without AEMany vomited even with AE 
 May be quicker and peaceful , but as Stan noted AEs are not required (may skip if trouble getting).
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| Are they available? | Depends on country . 
 
Importing prescription-only meds without prescription is illegal.Usually prescription onlyOTC – UK, Brazil, SpainOtherwise many acquired AE with little trouble:
Easy to ask a physician – example (original post)Search Internet , many online pharmaciesConsult existing threads (others looking for it) Antiemetics are very common , not "restricted substance" , investigation unlikely.
 Forging prescription is a crime (don't).
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| Warnings: | CAUTION 
 
Read medication side effects and warnings
Meto & Prochlorperazine may cause problems.Others also have side-effects, for heart conditions etc.Check contraindication to existing meds – drug interaction calculatorTest small dosage before ctb date
Mild effects – try small dose 8h later (tolerance = less side effects)Severe effects – avoid.Do not combine AEs from the 19 mentioned – use just one type
If Olanzapine taken – don't add Meto ; Quetiapine taken – don't add Meto | 
| Types | 
All 19 medications are potent .6 AEs – antiemetics – 3 of which are very common13 APs – antipsychotics 
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| Antiemetics (6) |  | 
| most common | . 
 1. Dromperidone2. Metoclopramide
 3. Prochlorperazine
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|  | 4. Olanzapine.5. Alizapride
 6. Chlorpromazine
 .
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| Will any antiemetic work? | NO. Guide provides 6 AEs – only use those.
 
 
Must target dopamine (Domperidone, Prochlorperazine)Preferably serotonin in addition (Metoclopramide) | 
| "Alternatives to Meto" | Yes . Plenty . 
 
Domperidone (with or without Ondansetron) , or Buccastem.There's a list – use it... | 
| Will X work as AE? | If not in guide and you've searched threads, then NO. | 
| AEs in detail |  | 
|  | 
	
		| Substance | Brand name | Indication | Availability | EPS Risk | D2 | 5HT3A |  | 1. Domperidone | Motilium | AE | Banned in US OTC in Asia
 | None | 7.5 | - |  | 2. Metoclopramide | Reglan, Primperan brands
 | AE | Rx OTC in Spain, Brasil, Asia
 | Low- 0.2% | 7.5 | 6.2 |  | 3. Prochlorperazine | Buccastem brands
 | Antipsychotic AE
 | OTC in UK | HIGH- 5% | 8.4 | - |  |  |  |  |  |  |  |  |  | 4. Olanzapine | Zyprexa brands
 | Antipsychotic CINV
 | Rx | Medium- 2% | 8.7 | - |  | 5. Alizapride |  | AE | Rx |  |  |  |  | 6. Chlorpromazine | Thorazine, Largactil | Antipsychotic AE
 | Rx | HIGH- 5% | 7.5 | - |  Domperidone efficient as Metoclopramide (research).
 Stan used Buccastem.
 Olanzapine very effective [1][2]
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| sources & notes | 
Sources:"No EPS": scarce casesReceptor Affinity: higher is "stronger" ; 1 pKi (100mM) – 9 pKi (10 nM)Effectiveness: mg ~ nM ~ effetive . Though not definitive (simple maths) .
Therapeutic dose of a drug (mg) correlates to affinity for D2 receptor (low nM)Average clinical potency (effective) correlates to affinity for dopamine receptorsAny drug with Ki < 50 nM would be remarkably helpfulDrugs above 4 pKi are considered to be binding [1] 
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| Other AEs? | DO NOT use – 
 
Serotonin or Histamine only are not as effective.Ondansetron/ZofranDiphenhydramine/BenadrylDimenhydrinate/Dramamine Read guide ; List of AE by type – dopamine antagonists (Wikipedia)
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| Why not Dramamine? | Histmine is responsible for body movements (Vestibular nucleus) , treats motion sickness 
 
Dramamine is not a good solution , though won't harm (unkown why PPH push these)Little to do with poisons, stomach, or CTZ .Lack prokinetic activitySee here | 
| Why not Ondansetron? | 
	
		
	
	
		
		
			"Metoclopramide is used by Dignitas and i think it's the recommened antiemetic in OD, the second one being domperidone, both dopamine antagonists. Ondansetron (Zofran) is a serotonin receptor antagonist and it's used for cancer patients undergoing chemotherapy because the irritation of the GI mucosa by the medication used in chemotherapy (which is cytotoxic and increase the levels of serotonin in the blood) are transmitted through the vagal nerve to the chemoreceptor trigger zone via activating serotonin receptors (5-HT3). It has no effect on dopamine receptors. "
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| In simple words? | Need broad systematic AE targeting both CTZ (brain) and stomach plus prokinetic. | 
| How vomiting works | Complex interactions: 
 
See graphic schema .Chemoreceptor Trigger ZoneVomiting CentreNucleus Tractus SolitariusGI tract chemoreceptors 
 .
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| Antipsychotics | (13) | 
| What are they? | If you do not take these regularly – DO NOT USE – this section is not for you. 
 They affect over weeks – so only if it is your regular medication.
 
 
Droperidol, Benperidol, Trifuperidol, Spiperone, Haloperidol, Bromperidol, Lurasidone, Sestindole, Paliperidone, Risperidone, Olanzapine, Clozapine, QuetiapineStan listed with nM (receptor affinity); lower numbers may indicate stronger effects. | 
| Warnings: | CAUTION 
 
ThereforeAbrupt dosage change – harmfulTampering is done over weeksEPS effectsHarsh withdrawal (psychosis) 
 
Don't take a single doseDon't double doseDon't change prescribed dosageDon't take Meto with Antipsychotics | 
| How much should I take? | As prescribed, don't change 
 
Personally-tailored – dosage varies greatly between individuals (explained here & here)Example . | 
| Do I need AEs with these? | NO. They cover all antiemetics requirements. 
 
If you use them regularly – you don't need any Meto or AEs. | 
| How do I use with Stat? | Replace AEs completely – use Stat directions – without Meto. 
 
Read directions and ignore any AE/Meto reference.Continue your AP regimen as usual (same dosage same time) . | 
| Quetiapine (Seroquel) is weak AE | It is considered a mild antiemetic – but still effective. 
 
.No conclusive, definitive answer.Potency only above 300mg –not verified by research (dosage and clinical efficacy for vomiting).
Receptor affinity is indicative , not conclusive.No simple maths hereAccumulative effects, receptor thershold, systematic, individual parameters (weight gender).Lower dosages (<100mg) considered by some to be ineffective . Many 'veteran patients' still consider it to be effective (BPD_LE notes) .May use alternatives ,  well detailed here | 
| Stat / Regimen |  | 
| What is it? | "Regimen/State" – only antiemetics. Two ways to take antiemetics:
 
 
Use only one of these schedules (either Stat or Regimen)One single dose – StatOver 24h-48h – Regimen For antiemetics only – nothing to do wit antipsychotics , benzo , antacids , etc
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| Stat or Regimen? | Both used with equal success. Depends on your sensitivities, conditions, and preferences.
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| Regimen | 
Builds tolerance – reduces side-effectsIncreased effectiveness – accumulates (also) – increased stomach tone over timeComfortable – feel prepared for ctb | 
| Stat | 
Efficacy appears similar with less hassle (no schedule)Less worry – like side effects during 2 daysComfortable – not demanding, no anxious wait, quick & simple | 
| So, which should I choose? | Up to you. Regimen came from PPH, for old/fragile/sick people. This may address you, could decrease discomfort.
 Stat is effective, easy option for many people. Take everything together.
 
 .
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| . Meto .
 | . (Metoclopramide).
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| Warnings: | Many are fine with it; some aren't; for a few poses a risk. Members reported other effects (non EPS):
 
 
Serious(meto stopped):
"I wanted to run out of my body""extreme unease in body, driving me crazy""made me feel very ill, my whole body"Mild(meto continued):
"after taking meto went to sleep 4 hour""throbbing headache" | 
| Prochlorperazine | Not Meto, but same warnings. 
 
Prochlorperazine has higher EPS risk | 
| Why Meto preferred? | Only antiemetic that: 
 
This means:Targets both dopamine and 5HT3, andCrosses into the brain 
 
However alternatives (5) are fine.Strong stomach emptying effectStrong anti-vomiting vomiting effect | 
| Strong effects without Meto? | Ondansetron and Domperidone target peripheral receptors, not the brain (less side effects): 
 Domperidone (Dopamine, less EPS)
 +
 Ondansetron (5HT3, less EPS)
 =
 Metoclopramide (Dopamine+5HT3 , Brain/EPS)
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| Bad Meto reaction – what to do? | Take Diphenhydramine/Benadryl 'Failing Meto' is fine
 
 
.Use any of the other 5 on the list, orCtb without antiemetics (many have done so but follow guide) | 
| Stat & Regimen | Guidelines | 
| Dosages / schedule? | Read guide. Follow everything there. 
 – This section is only more details not in guide –
 .
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| Meto |  | 
| Regimen | See guide. Schedule is however more flexible –
 
 
Just take 3 a day over 24-48h
morning lunch evening, 7-9h apart | 
| Domperidone |  | 
| Stat | Same as meto. Notes
 | 
| Regimen | Same as meto. 
 Best to stick with it. Member was fine after trying 48h regimen x 20mg (instead of 10mg)
 Research concludes:
 
 
Acummulation – "2 to 3-fold accumulation observed with repeated 4 times daily every 5 hr for 4 days."But only 3+ a day – "after two weeks of single 30mg per day peak plasma level almost same" | 
| Prochlorperazine |  | 
| General info | Buccastem tablets are 3mg each. Keep Benadryl/diphenhydramine on standby (used to treat EPS)
 Place tablets under upper lip and wait 1-2 hours to dissolve.
 Notes , Notes
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| Stat | Smaller dosage– 10 to 20 mg Suggestion: if you are small, take 4 tablets ; medium sized- 5 tablets ; large person- 6 tablets
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| Regimen | Same as Meto (10mg x 3 times a day) – but final dose smaller like Stat | 
| Fasting |  | 
| Is it important? | Yes, SN to intestines. However it is flexible– don't overdo it, follow habits, see FAQ- Fasting.
 
 
5h – Empty stomach, partially small intestines – Good enough.8h – Empty most small intestines – Good.12h – Long fasting not required (may cause discomfort).
According to your habits/feeling; if you eat just twice a day, 12h fine. |